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Several hon. Members rose--

Madam Speaker: Order. After that very long initial exchange, there will have to be brisk questions and answers.

Mr. Roger Sims (Chislehurst): Is it not clear that, when distressing problems arise, they are due not to any fault on the part of clinicians or to lack of resources, but to shortcomings in bed management? May I therefore welcome my right hon. Friend's statement and, in particular, his strengthening of the patients charter, which will give an incentive for better and more efficient use of beds?

My right hon. Friend may recall that, when I initiated a debate on intensive care bed provision in London last July, following the incident in which one of my constituents had to be helicoptered to Leeds, I suggested that there should be some form of national computer register of intensive care bed availability. I welcome his statement that that is now being considered, and I hope that it will be brought into effect as soon as possible.

Mr. Dorrell: I am grateful to my hon. Friend. As I said in my statement, exactly that principle is now working in London and has improved intensive care bed management in London and the south-east since it was extended last April. Against the deadline that I announced, we shall review the idea that the computer register should be extended to cover the whole country.

I am grateful that my hon. Friend welcomed the charter proposal. We need to ensure that the charter sets out clear standards for service that are acceptable to patients and are also recognised by those who work in the service as relevant measures of quality.

Mr. Alfred Morris (Manchester, Wythenshawe): Is it not deeply shocking and grossly unacceptable that 64 hospital beds are now being closed in south Manchester, including four intensive care beds about which I tabled a parliamentary question to the right hon. Gentleman last Wednesday for priority reply today? While we both know the reasons given for these closures, is there anything he can now do against the background of his statement today

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to help, and, more especially, to save the four intensive care beds--because, as he knows, and indeed as we all know, closing intensive care beds costs lives?

Mr. Dorrell: The number of intensive care beds in the north-west, Liverpool and Manchester is being not reduced but increased. Paediatric intensive care provision in the north-west has risen from 20 to 30 available beds since 1993, which reflects the investment in available space. I have already announced to the House the steps that I am taking to ensure sufficient paediatric intensive care beds and that they are effectively used.

Dame Angela Rumbold (Mitcham and Morden): I warmly welcome my right hon. Friend's comments about the use of intensive and emergency care beds in the Greater London area. When he writes to chief executives in central and outer London hospitals, perhaps he will address a problem identified by my two local hospitals.A number of elderly people admitted to intensive care beds have been unable to move elsewhere, so continuing to occupy beds that could be used to better purpose. There must be closer co-operation between local care in the community social services and health services. If that were given high priority, it would help enormously.

Mr. Dorrell: My right hon. Friend is precisely right, which is why the relationship between hospitals and social services departments will be specifically addressed by the review.

Mr. Simon Hughes (Southwark and Bermondsey): If some of the improvements that the Secretary of State identified are delivered, that will be welcome. Does the right hon. Gentleman accept that the test of whether the health service is working is whether it meets the needs that are clearly apparent? Does the right hon. Gentleman intend to ensure enough A and E consultants throughout the country?

Does the Secretary of State acknowledge the rising demand for intensive and paediatric intensive care beds because of the health service's success in keeping alive people who previously would have died? Some regions have an overall bed shortage. If the review concludes that more money is needed to buy what are expensive NHS resources, will the Secretary of State go into battle in the forthcoming Treasury expenditure round for money to meet the service's basic care needs?

Mr. Dorrell: The hon. Gentleman asks whether I am committed to ensuring sufficient A and E capacity to meet demand. The answer is yes. At consultant, junior doctor and nursing level, we have seen the fastest growth among professional staff in A and E departments in recent years, with a 35 per cent. increase in A and E consultants.

We need to ensure that, if demand continues to increase, as it seems reasonable to expect, we have growing professional resources to meet it. We shall keep a close eye on intensive bed capacity, although the position is more open. One conclusion of the review that I am publishing today is that one in six patients currently occupying an intensive care bed do not need the level of care provided in intensive units. In those circumstances,a substantial increase in capacity is available if we can meet those patients' needs in the kind of high-dependency bed described in my statement.

Sir Donald Thompson (Calder Valley): Does my right hon. Friend recall that, when a Labour Government were

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in charge, hospital admissions were at the whim of the union convener? He said who should go into hospital, and his friends would not bury the dead that resulted. [Hon. Members: "Oh."] Does my right hon. Friend agree that emergency intensive care and what has become routine intensive care should be used as flexibly as possible--but that such flexibility will lead to even more smears and less help from the Opposition?

Mr. Dorrell: My hon. Friend is precisely right. The reaction of Labour Members is a reminder of how much they dislike being reminded of their record in government in respect of the national health service. Labour was responsible for the only cut in recent years in funding available to the NHS, and for cutting nurses' pay during its time in office. My hon. Friend reminds the House that Labour was responsible for a state of affairs in which access to hospital was determined not by doctors but by the local NUPE official, as he or she then was.

That is the record of Labour in office. My hon. Friend is quite right to remind the House of that, and to draw a sharp contrast between what used to happen and what happens today, when the overwhelming experience of NHS patients, whether they need emergency care or planned care, is that care is delivered to a higher standard than ever before in the history of the NHS.

Ms Ann Coffey (Stockport): I am grateful to the Secretary of State for offering the sympathy of the whole House to the Geldard family, but that really does not go far enough. The inquiry into Nicholas's death was a damning indictment of the health service on that night. The right hon. Gentleman should apologise to the Geldard family for the failures of that night, because ultimately the responsibility is his, and the situation should have been sorted out a long time ago.

Mr. Dorrell: Hon. Members' sympathy is real and is felt on both sides of the House--I agree with the hon. Lady on that. It is important, following the inquiry, that all necessary steps are taken to ensure that such circumstances do not happen again. The regional health authority has made a series of announcements since the publication of the inquiry, stating that it will take the various measures that the inquiry recommended to improve the quality of care. I have announced what I intend to do about paediatric intensive care units around the country.

A further matter that local interests in Manchester must address is the fact that some of the report's most stinging criticism was aimed at the failure of the health service and local authorities to allow the reorganisation of neurosurgery services and paediatric services in the city. The health service has proposed plans for the consolidation of neurosurgery and of paediatrics. Those plans were opposed by Manchester city council, and that has delayed their implementation.

We need to ensure that all the lessons are learned, not just some of them. The regional health authority is learning them. I have made it clear to the House that I am learning them; I hope that others will do so, too.

Mr. Richard Tracey (Surbiton): I strongly support the point made by my right hon. Friend the Member for Mitcham and Morden (Dame A. Rumbold) about hospital beds, especially in south-west London.

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Is my right hon. Friend aware that my local hospitals in Kingston have a logjam of 40 beds--St. Helier hospital has a logjam of 60 beds--caused by elderly patients who are not acute or emergency patients but who are awaiting assessment and placement in nursing home beds by the social services department? Will he do something about those social services departments, particularly in Surrey county council, in Richmond, and in Merton? Or can we introduce some new form of bed--a nursing home bed--to cope with this state of affairs, because it is truly affecting the desperately needed acute services?

Mr. Dorrell: My hon. Friend is entirely right to stress the importance of the relationship between hospitals and social services departments. In both the cases to which he referred, councils that are controlled by Liberal interests were responsible for those social services departments.

My hon. Friend asked what we are doing to ensure the best possible partnership between the NHS and social services departments. Part of the answer is contained in my statement: the need to ensure that accident services are planned in conjunction with social service departments. Another part of the answer is the huge increase in the resources that the Government have voted to social services departments throughout the country.

Social services departments in local authorities are some of the fastest growing programmes in any part of government. In looking for the partnership that my hon. Friend rightly says is necessary, we are entitled to look at the level of resources that have gone to social services departments, and then look for the partnership that is indeed necessary to ensure that we deliver an efficient and effective hospital service.

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